Provider Demographics
NPI:1972096154
Name:WALDREP, MAGEN MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:MAGEN
Middle Name:MARIE
Last Name:WALDREP
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 ALBACORE CT
Mailing Address - Street 2:
Mailing Address - City:HUBERT
Mailing Address - State:NC
Mailing Address - Zip Code:28539-1001
Mailing Address - Country:US
Mailing Address - Phone:478-279-2206
Mailing Address - Fax:
Practice Address - Street 1:1309 NC HIGHWAY 210
Practice Address - Street 2:
Practice Address - City:SNEADS FERRY
Practice Address - State:NC
Practice Address - Zip Code:28460-9144
Practice Address - Country:US
Practice Address - Phone:910-327-2052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist